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Since 1975, the number of bicycling-related deaths per person has fallen significantly for children but risen for adults.Identifying and implementing effective strategies to encourage safe bicycling while reducing bicycling-related deaths improves public health.Bicycling is an increasingly popular common form of physical activity and transportation. Since 1975, the number of bicycling-related deaths per person has fallen significantly for children but risen for adults. Some states have fewer bicycling related deaths per person than others. This report examines mortality trends among cyclists using national collision data from the Fatality Analysis Reporting System (FARS) for the period 1975–2012. Annual rates for cyclist mortality decreased 44%, from 0.41 to 0.23 deaths per 100,000 during this period, with the steepest decline among children younger than age 15. In recent years, reductions in cyclist deaths have slowed. However, age-specific cyclist mortality rates for adults aged 35–74 years have increased since 1975.

Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water — United States, 2011–2012

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The proportion of drinking water-associated outbreaks caused by Legionella has increased to nearly two-thirds of the outbreaks reported in 2011-2012; the key to preventing these outbreaks is maintenance of building plumbing systems. In 2011 and 2012, 32 waterborne disease outbreaks linked to drinking water systems were reported to CDC; these included 431 cases of illness. Nearly two-thirds of drinking water-associated outbreaks were caused by Legionella, and the proportion of outbreaks caused by Legionella has doubled between 2007-2008 and 2011-2012. Legionella can cause severe pneumonia in susceptible individuals after they breathe air containing tiny droplets of contaminated water. The problems that lead to Legionella outbreaks in drinking water systems can often be traced to facility plumbing, and not public, federally-regulated water systems. Most of the other outbreaks were caused by consuming groundwater contaminated with viruses, especially Norovirus, and bacteria other than Legionella. In 2011 and 2012, the number of outbreaks linked to problems in public water systems has declined compared with previous reports.

Outbreaks Associated With Environmental and Undetermined Water Exposures — United States, 2011–2012

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Fifteen of 18 outbreaks associated with environmental or undetermined water exposures were caused by Legionella; the key to preventing Legionella and other bacteria from growing in water is maintenance of water systems, including drinking water systems, hot tubs, decorative fountains, and cooling towers. Waterborne disease outbreaks can occur following different types of human exposure to water. This report summarizes outbreaks associated with exposures to environmental (e.g. backcountry streams, and aerosols from ornamental fountains and cooling towers) and undetermined sources of water, reported in the US. During 2011 and 2012, CDC received reports of 18 outbreaks, 280 outbreak-associated cases and 10 deaths associated with environmental and undetermined water exposures. Fifteen of 18 outbreaks and all 10 deaths were caused by Legionella, a bacterium that can cause severe pneumonia in susceptible individuals. Infection can occur after people breathe aerosols, or air containing tiny droplets of water, contaminated with the bacteria. Of the 15 Legionella outbreaks, six occurred in healthcare settings. An additional three outbreaks were caused by Giardia intestinalis, an intestinal parasite, following ingestion of untreated water directly from rivers or streams.

Hobbyist and commercial coral growers, public health practitioners, and health care providers need to be aware of the potential health consequences of handling certain marine zoanthid corals.In August 2014, public health officials with the Alaska Section of Epidemiology received a report of a patient complaining of bitter metallic taste, fever, weakness, cough, and muscle pain 7 hours after introduction of live zoanthid coral into his home aquarium. An epidemiologic investigation revealed at least ten aquarium enthusiasts reporting similar symptoms consistent with palytoxin exposure in recent years, including multiple employees at an Anchorage aquarium shop. Palytoxin, a potent toxin known to produce the reported effects, is contained in some zoanthid marine corals. Zoanthid samples from both commercial and private aquariums of affected persons were found to contain high levels of palytoxin. Activities that could potentially produce aerosols (e.g., scrubbing or using hot water to remove zoanthids) should be undertaken with caution when cleaning marine aquariums or handling zoanthid corals.

Notes from the Field:

Investigation of Tuberculosis in a High School — San Antonio, Texas, 2012

Use and Interpretation of a Rapid Respiratory Syncytial Virus Antigen Detection Test Among Neonates Hospitalized in a Neonatal Intensive Care Unit — Wisconsin, March 2015

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Percentage of Office-Based Primary Care Physicians Not Accepting New Patients, by Source of Payment — United States, 2013